关节镜下与开放型肩袖修复术：哪种并发症更少，30 天再入院率更低？
Arthroscopic Versus Open Rotator Cuff Repair: Which Has a Better Complication and 30-Day Readmission Profile?
机构信息
University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
University of Alabama at Birmingham, Birmingham, Alabama, U.S.A..
出版信息
Arthroscopy. 2017 Oct;33(10):1764-1769. doi: 10.1016/j.arthro.2017.04.019. Epub 2017 Jul 5.
PURPOSE
To provide a comparative 30-day postoperative analysis of complications and unplanned readmission rates, using the National Surgical Quality Improvement Program database, after open or arthroscopic rotator cuff repair (RCR).
METHODS
The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for postoperative complications after open or arthroscopic RCR over an 8-year period, from 2007 through 2014. Patients were identified by use of Current Procedural Terminology codes. The open group contained 3,590 cases (21.8%) and the arthroscopic group had 12,882 cases (78.2%), for a total of 16,472 patients undergoing RCR. The risk of complications was compared between the 2 groups, along with patient demographic characteristics, operative time, length of stay, and unplanned readmission within 30 days. We compared dichotomous variables using the Fisher exact test and continuous variables with 1-way analysis of variance. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated when appropriate.
RESULTS
The open RCR group had a higher prevalence of patients aged 65 years or older and comorbidities such as hypertension, diabetes, chronic obstructive pulmonary disease, smoking, and alcoholism (P < .05). Patients undergoing open RCR had a higher risk of any adverse event when compared with arthroscopic RCR patients (1.48% vs 0.84%; RR, 1.17; 95% CI, 1.05-1.30; P = .0010). They were also at higher risk of return to the operating room within 30 days (0.70% vs 0.26%; RR, 1.36; 95% CI, 1.09-1.69; P = .0004). Open RCR was associated with a longer average hospital stay (0.48 ± 2.7 days vs 0.23 ± 4.2 days, P = .0007), whereas arthroscopic RCR had a longer average operative time (90 ± 45 minutes vs 79 ± 45 minutes, P < .0001).
CONCLUSIONS
Although both open and arthroscopic approaches to RCR had low morbidity, arthroscopy was associated with lower risks of any adverse event and return to the operating room during the initial 30-day postoperative period.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
目的
利用美国外科医师学会国家手术质量改进计划（National Surgical Quality Improvement Program，NSQIP）数据库，对开放式或关节镜下肩袖修复术（rotator cuff repair，RCR）后 30 天内的并发症和非计划性再入院率进行比较分析。
方法
回顾性分析 2007 年至 2014 年期间美国外科医师学会 NSQIP 数据库中接受开放式或关节镜下 RCR 患者的术后并发症。使用当前操作术语（Current Procedural Terminology，CPT）代码识别患者。其中开放式组 3590 例（21.8%），关节镜组 12882 例（78.2%），共 16472 例患者接受 RCR。比较两组之间的并发症风险，以及患者的人口统计学特征、手术时间、住院时间和 30 天内非计划性再入院情况。采用 Fisher 确切检验比较二分类变量，采用单因素方差分析比较连续变量。当合适时，计算相对风险（relative risk，RR）和 95%置信区间（confidence interval，CI）。
结果
开放式 RCR 组患者年龄≥65 岁和合并症（如高血压、糖尿病、慢性阻塞性肺疾病、吸烟和酗酒）的比例较高（P<0.05）。与关节镜 RCR 患者相比，开放式 RCR 患者发生任何不良事件的风险更高（1.48% vs. 0.84%；RR，1.17；95%CI，1.05-1.30；P=0.0010）。前者在 30 天内再次手术的风险也更高（0.70% vs. 0.26%；RR，1.36；95%CI，1.09-1.69；P=0.0004）。开放式 RCR 患者的平均住院时间较长（0.48±2.7 天 vs. 0.23±4.2 天，P=0.0007），而关节镜 RCR 患者的平均手术时间较长（90±45 分钟 vs. 79±45 分钟，P<0.0001）。
结论
尽管开放式和关节镜式 RCR 均具有较低的发病率，但在术后 30 天内，关节镜式 RCR 与任何不良事件和再次手术的风险较低相关。
证据等级
III 级，回顾性比较研究。
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